What should be cared about in the management of complex severe spinal deformity?
Severe spinal deformity is not an uncommon condition that often arises from untreated early onset scoliosis in developing countries. Patients most often present with severe clinical and radiographic deformity with poor pulmonary function. Previous literature has identiifed the challenges in the treatment of these patients and the higher risk for complications. An assessment of the preoperative, intraoperative, and postoperative factors leading to an optimal result was warranted. The early evaluation should include a multidisciplinary approach from orthopaedic surgeon, pulmonologist, anesthesiologist, and perhaps neurologist to provide a baseline assessment. Advanced imaging of the spine is useful and important. Current surgical strategies include aggressive anterior and posterior column release and osteotomies, either with a front–back or a posterior-only approach. With the extent of the surgical release and segmental instrumentation, the potential for curve correction is increased;however, so is the potential for neurologic compromise. Therefore, perioperative Halo traction is recommended. It is thought to improve both spinal deformity and pulmonary function and is a helpful adjuvant in the treatment of severe spinal deformity. Improvement in the clinical and radiographic appearance, pulmonary function, and self-image is often dramatic. Proper planning and execution of the correct surgical procedure for the surgeon provides an outstanding life-changing result in these patients.更多